Cooperating for better care.

Blue Cross Blue Shield of Massachusetts

Tag Archives

Pricey pills drive system to ‘precipice’

pills

The Boston Globe discusses how pricey new drugs, many of them developed in the Boston area, threaten to  derail the healthcare system.

“But instead of affordable Fords and Chevys, our hometown  {Boston area} firms are cranking out Lamborghinis and Bentleys. They make expensive drugs that are steering the healthcare system toward a precipice. ”

“{T}he industry has been doing everything in its power to make itself look like Monty Burns, the money-hungry mogul who owns the nuclear power plant on The Simpsons.”

One big way Big Pharm continues to drive up costs is by doing all that it fan to keep out biosimilars. “Express Scripts estimated that if just 11 biosimilars were introduced for drugs coming off parent, about $250 billion could be saved over a decade.”

Then there’s the surging pay of execs in biotech.

The Globe notes: “Finally, the price of the products has started to make headlines. A new two-drug combination from Vertex to treat cystic fibrosis, on the verge of FDA approval, is expected to cost north of $300,000 per year. ”

And The Globe says:

{“T}he price is often determined by asking, ‘What’s the highest price I can charge and get away with,’ said Alison Taunton-Rigby, a former biotech executive who serves on several corporate and nonprofit boards. Speaking at a recent industry conference, Taunton-Rigby said, ‘It’s an attitude we need to talk about. I think we actually have a black mark against us as an industry.”’

But insurers are pushing back.

“Tony Dodek, associate chief medical officer at Blue Cross Blue Shield of Massachusetts, says high-priced ‘specialty drugs’ represent just 1 percent of the prescriptions handed to Blue Cross’ members, but 25 percent of the insurer’s spending on drugs, a share that is rising rapidly. ‘That’s not sustainable,’ Dodek says.”

 


Mass. Blue Cross wants to expand global budgets

 

Modern Healthcare reports that Blue Cross Blue Shield of Massachusetts ”wants to expand its use of global budgets outside of managed care. But the plan’s success will depend on how many doctors are willing to accept the risk.

”Doctors across the country have criticized Medicare’s accountable care contracts that make physicians responsible for curbing health spending without allowing them to influence where and when patients get care. But the Massachusetts Blues in recent weeks began to approach the state’s medical groups with a similar proposal.

”The company plans to introduce global budgets in its preferred provider organization health plans. The new model comes seven years after the insurer first offered global budgets in its managed care plans under what it calls Alternative Quality Contracts. ”


Revolution in Mass. insurance system

 

Yet again, Massachusetts is  a pacesetter for health-insurance reform.

The Boston Globe reports that Blue Cross Blue Shield of Massachusetts ”will vastly expand its system that pays doctors based on how well they care for patients {aka fee for value}— not just for the number they see and volume of services they provide {aka fee for service}. The move will extend the quality-based system to more than 1 million health plan members, making it the biggest initiative of its kind in the state and probably the country.”

”The move by Blue Cross, which controls 40 percent of the state’s commercial insurance market, should hasten the decline of the way American doctors have been paid for decades, analysts said”.

The Globe elaborated: “Blue Cross will essentially pay doctors a set amount to care for their patients but payments will ultimately be tied to how well doctors and hospitals score on a variety of quality measures.

”For consumers, the change will mean more coordinated care and management, such as follow-up visits by home aides after surgery and phone calls to make sure patients take their medicine.”

 


Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, Mass